Name and levels of the retreat you are booking for (I,II or I,II & III)
Date of the retreat you are booking for

Date of Birth

Country of Birth
How did you come to know about Z Meditation?

What is it in life that you seek?

How is your life at the moment? (write a short summary)

What are you expecting from this retreat?

Do you have any food or environment allergies?

Please briefly describe your meditation experience

Please briefly describe your yoga experience

If you have a spouse, partner or family member participating in the retreat, please
give details
Do you have any health problems such as diabetes, asthma, high blood pressure,
hepatitis, epilepsy, heart disease, etc?

Are you consuming any drugs such as narcotics, cocaine, marijuana, heroine etc?
If so, please give details such as
quantities and frequency of consumption

Are you currently under doctor's care and/or taking medications? If so, please
specify both the condition and the medication. Are you currently taking anti-
depressants, mood altering drugs, supplements or tranquilisers?

Please briefly describe your experience with Meditation / Yoga workshops or group

Do you really feel that you are ready for this most sublime experience of
meditation and will put in the required effort in learning?


Legal Signature: Write your name for affirming that you will follow all rules and
regulations in the retreat.